A Gunshot Wound's Hidden Surprises

I stood peering into the patient’s abdomen, feeling like an animal chased to the edge of a cliff. I knew that at some point the only option was to dive into the chasm.

The anesthesiologist’s voice sounded from the head of the bed. “Pressure’s still not good — I’m pushing fluids.” His eyes widened as he looked over the blue paper drape at the bloody mass. “Oh my God,” he murmured. “What’s your plan?”

I was a senior surgical trainee on rotation at a small downtown hospital not far from the university medical center where I normally worked — and where a trauma center surgical team was on duty every night. Here, I was the only surgeon on site after hours. Ambulance drivers routed seriously injured patients here only when police performed a “scoop and drop,” bringing a patient to the nearest hospital.

The ER doctor’s phone call awoke me in the call room at 3 a.m., and the message was terse: “Gunshot wound. Unstable. Hurry.”

In the ER I found a nurse struggling to place an IV in a young man lying shirtless and unconscious on a stretcher. He had two gunshot wounds to his upper right abdomen.

“We have to get him to the operating room, now,” I shouted. I asked the nurse to get the on-call surgeon, Dr. Jones.

I pushed the patient’s stretcher out of the ER and into the operating room, where a nurse was waiting to prep him. A few minutes later, I was scrubbed in. “Does anyone know if Dr. Jones is en route?” I asked.

“No word,” the anesthesiologist answered.

“I may have to start without him,” I said. To delay for even a few minutes could mean the patient would bleed to death...

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